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Finals - Ophthalmology > Anterior uveitis > Flashcards

Anterior uveitis Flashcards

1
Q

What is anterior uveitis/iritis?

A

Inflammation of the anterior part of the uvea.

Anterior chamber of the eye becomes infiltrated with neutrophils leucocytes and macrophages.

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2
Q

What makes the uvea?

A

Iris, ciliary body and the choroid.

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3
Q

What is the choroid?

A

The layer between the retina and sclera all the way around the eye.

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4
Q

What are the causes of anterior uveitis?

A

Autoimmune (usually)

Infection

Trauma

Ischaemia

Malignancy

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5
Q

Clinical presentation of anterior uveitis?

A

Unilateral symptoms starting spontaneously.
Floaters
Dull aching red eye
Ciliary flush (redness from cornea outwards)
Reduced visual acuity
Miosis
Photophobia
Pain on eye movement
Excessive tear production
Abnormally shaped pupil due to posterior synechiae.
Associated flare of autoimmune disease.

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6
Q

Pathophysiology of chronic anterior uveitis?

A

Chronic - more macrophages. Less severe and longer duration of symptoms lasting more than 3 months.

Associated with granulomatous type conditions
e.g. Sarcoidosis, TB, Syphillis and Herpes.

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7
Q

What markers are associated with anterior uveitis?

A

HLA-B27 positive conditions.

Ankylosing spondylitis

Inflammatory bowel disease

Reactive arthritis

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8
Q

Management of anterior uveitis?

A

Referred for same day assessment by ophthalmologist as sight threatening cause of red eye.

Full slit lamp assessment.
Managed by specialist with steroids, cycloplegia mydriatic medications (e.g. Cyclopentolate and atropine drops - antimuscarinic drops that will block action of sphincter muscles and ciliary body)
DMARD’s/TNF inhibitors.
Surgical intervention.

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9
Q

What is episcleritis?

A

Benign self limiting condition causing inflammation of the episclera.

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10
Q

Clinical presentation of episcleritis?

A

Common in middle aged adults

Acute onset unilateral symptoms. 
mild discomfort/pain 
Segmental redness - usually lateral sclera. 
Foreign body sensation 
Eye watering

NO DISCHARGE.

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11
Q

Anatomical location of the episclera?

A

Directly underneath the conjunctiva

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12
Q

What is episcleritis associated with?

A

Inflammatory disorders such as RA and inflammatory bowel disease.

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13
Q

Management of episcleritis?

A

Refer to ophthalmology if diagnostic doubt.

Self limiting condition with full recovery in 1-4 weeks.

Conservative: lubricating eyedrops, analgesia, cold compresses and safety netting advice.

If severe, may benefit from Naproxen or topical steroid eyedrops under the guidance of specialist.

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14
Q

What is scleritis?

A

Inflammation of the full thickness of sclera. More serious than episcleritis.

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15
Q

What is the most serious type of scleritis?

A

Necrotising scleritis - have reduced visual acuity but no pain

May lead to perforation of the sclera.

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16
Q

associated conditions to scleritis?

A

Associated condition in 50% patients.

RA
SLE
IBD
Sarcoidosis 
Granulomatosis with polyangitis.
17
Q

Clinical presentation of scleritis?

A 
50:50 bilateral unilateral 
acute onset usually 
Red dilated vessels underneath sclera - not movable with a cotton wool bud. 
Pain on eye movement
Eye watering 
Reduced visual acuity 
Photophobia 
Abnormal pupil reactions to light 
Tenderness on palpation of the eye
18
Q

Management of scleritis?

A

Same day referral to ophthalmologist

Management of underlying condition

Topical NSAID’s

Steroids - topical or systemic

19
Q

What are corneal abrasions?

A

Scratches or damage to the cornea leading to red painful eye.

20
Q

Common causes of corneal abrasions?

A

Contact lenses - associated pseudomonas underlying infection is common.

Finger nails

Eyelashes

Entropion

21
Q

Important underlying infections to consider in patients with corneal abrasions?

A

Herpes simplex virus - treated with antiviral eyedrops

Pseudomonas infection in patients with contact lens associated abrasions.

22
Q

Clinical presentation of corneal abrasion?

A

History of contact lens use or foreign body

watering eye

blurred vision

red eye

photophobia

23
Q

Diagnosis of corneal abrasion?

A

Fluorescein stain - collects indents in eye from abrasions or ulcers.

Slit lamp examination to diagnose more significant abrasions

24
Q

Management of corneal abrasions?

A

Simple analgesia (paracetamol)

Lubricating eyedrops

Antibiotic eyedrops as treatment/prophylactic

Review in one week

Cyclopentolate eyedrops aid in photophobia - not always necessary

25
Q

How long do corneal abrasions take to heal?

A

Uncomplicated corneal abrasions usually take 2-3 days to heal.

26
Q

What is herpes keratitis?

A

inflammation of the cornea

27
Q

Clinical presentation of herpes keratitis?

A 
Painful red eye 
Photophobia 
Vesicles around eye 
Foreign body 
Watering eye 
Reduced visual acuity 
Staining with fluorescein
28
Q

Causes of keratitis?

A

Viral infection - Herpes

Bacterial infection - e.g. Pseudomonas or Staphylococcus

Fungal infection - e.g. Candidiasis or Aspergillus

Contact lens acute red eye - eclare

Exposure keratopathy - e.g eyelid ectropion.

29
Q

Most commonly affected location in keratitis?

A

Epithelial layer of the cornea

30
Q

How do you diagnose Herpes keratitis?

A

Fluorescein staining which causes a dendritic corneal ulcer.

Slit lamp examination

Corneal swabs/scrapings can be used for viral PCR.

31
Q

Management of Herpes keratitis?

A

Sight threatening causes of red eye should be referred for same day assessment by ophthalmologist

Aciclovir - topical or oral.

Topical steroids as an adjunct to treat inflammation, especially in stromal keratitis.

Corneal transplants indicated in corneal scarring caused by stromal keratitis.

32
Q

Management of Herpes keratitis?

A

Sight threatening causes of red eye should be referred for same day assessment by ophthalmologist

Aciclovir - topical or oral.

Topical steroids as an adjunct to treat inflammation, especially in stromal keratitis.

Corneal transplants indicated in corneal scarring caused by stromal keratitis.

33
Q

What is a subconjunctival haemorrhage?

A

Small blood vessels in conjunctiva ruptures and releases blood in the sclera.

34
Q

What causes subconjunctival haemorrhage?

A

Mostly idiopathic

Predisposal to these in conditions including hypertension, bleeding disorders (e.g. thrombocytopenia), whooping cough, non accidental injury.

Can be caused by straining - e.g. coughing and lifting.

35
Q

How do subconjunctival haemorrhage present?

A

Bright red blood underneath the conjunctiva in front of the sclera (covering white part of eye).

Painless, vision not affected.

36
Q

Management of subconjunctival haemorrhages?

A

Harmless and will spontaneously resolve without treatment.

Finals - Ophthalmology (7 decks)

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